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Purpose: To summarize the results of a consensus meeting aimed at defining terminology for widefield imaging across all retinal imaging methods and to provide recommendations for the nomenclature used to describe related images., Design: An international panel with expertise in retinal imaging was assembled to define consensus terminology for widefield imaging and associated terminology., Participants: A panel of retina specialists with expertise in retinal imaging., Methods: Before the consensus meeting, a set of 7 images acquired with a range of imaging methods and representing both healthy and diseased eyes was circulated to the expert panel for independent assignment of nomenclature for each example. The outputs were assembled and used as the starting point for discussions occurring at a subsequent roundtable meeting. The anatomic location, field of view, and perspective provided by each image example was reviewed. A process of open discussion and negotiation was undertaken until unanimous terminology for widefield imaging was achieved., Main Outcome Measures: Definitions of widefield imaging applicable to multiple imaging methods., Results: Across a range of different imaging methods, the expert panel identified a lack of uniform terminology being used in recent literature to describe widefield images. The panel recommended the term widefield be limited to images depicting retinal anatomic features beyond the posterior pole, but posterior to the vortex vein ampulla, in all 4 quadrants. The term ultra widefield was recommended to describe images showing retinal anatomic features anterior to the vortex vein ampullae in all 4 quadrants. The definitions were recommended over other device-specific terminology., Conclusions: A consistent nomenclature for widefield imaging based on normal anatomic landmarks that is applicable to multiple retinal imaging methods has been proposed by the International Widefield Imaging Study Group. The panel recommends this standardized nomenclature for use in future publications., (Copyright © 2019 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the feasibility and clinical utility of a novel noncontact scanning laser ophthalmoscope-based ultra-widefield indocyanine green angiographic system., Methods: Ultra-widefield indocyanine green angiographic images were captured using a modified Optos P200Tx that produced high-resolution images of the choroidal vasculature with up to a 200° field. Ultra-widefield indocyanine green angiography was performed on patients with a variety of retinal conditions to assess utility of this imaging technique for diagnostic purposes and disease treatment monitoring., Results: Ultra-widefield indocyanine green angiography was performed on 138 eyes of 69 patients. Mean age was 58 ± 16.9 years (range, 24-85 years). The most common ocular pathologies imaged included central serous chorioretinopathy (24 eyes), uveitis (various subtypes, 16 eyes), age-related macular degeneration (12 eyes), and polypoidal choroidal vasculopathy (4 eyes). In all eyes evaluated with ultra-widefield indocyanine green angiography, high-resolution images of choroidal and retinal circulation were obtained with sufficient detail out to 200° of the fundus., Conclusion: In this series of 138 eyes, scanning laser ophthalmoscope-based ultra-widefield indocyanine green angiography was clinically practical and provided detailed images of both the central and peripheral choroidal circulation. Future studies are needed to refine the clinical value of this imaging modality and the significance of peripheral choroidal vascular changes in the diagnosis, monitoring, and treatment of ocular diseases.

A 23-year-old woman with history of headaches and auditory changes presented with acute-onset visual field loss in the right eye. The combination of multiple retinal branch artery occlusions of the right eye on funduscopic examination, characteristic white matter lesions in the corpus callosum on magnetic resonance imaging, and hearing loss on audiometric testing led to a diagnosis of Susac's syndrome. Ultra-widefield fluorescein angiography revealed involvement of the retinal veins, which has not been previously reported with this condition. Additionally, ultra-widefield indocyanine green angiography demonstrated changes in the choroidal circulation, which are controversial in this syndrome., (Copyright 2014, SLACK Incorporated.)

Purpose of Review: Ultra-wide-field fluorescein angiography (UWFA), which captures up to 200° of retina in a single image, now affords us the ability to angiographically examine the parts of the retina previously not photographable. Here, we review the role of UWFA in the management of retinal disease., Recent Findings: UWFA effectively images the abnormality in a variety of retinal conditions, including diabetic retinopathy, retinal vein occlusion, sickle cell retinopathy, uveitis, and pediatric retinal disease, in turn guiding both diagnosis and management of these conditions., Summary: UWFA is a useful imaging modality that is expected to become increasingly incorporated into the practice of retina. This will likely fuel the studies to determine how to reconcile the findings from UWFA with practice guidelines based on the studies conducted prior to the development of UWFA.

The retinal periphery is the site of pathology in several eye diseases. Imaging of the peripheral retina offers a way to diagnose, monitor, and evaluate responses to the treatment of these conditions. Traditional fundus cameras have offered a 30- to 50-degree field of view. Recent technology has advanced to provide up to a 200-degree field of view. The utility of this technology in clinical practice continues to be investigated; wide-field color photography, autofluorescence imaging, and fluorescein angiography have been used for imaging peripheral retinal disease. Due to the limitations of this imaging technology and the lack of normative data, however, the clinical role of wide-field imaging remains controversial., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Purpose: To describe the peripheral autofluorescent findings in patients with age-related macular degeneration (AMD) using ultrawide-field imaging., Methods: We retrospectively reviewed the ultra-wide-field autofluorescent images of all patients diagnosed with AMD or macular drusen at the Department of Ophthalmology of Weill Cornell Medical College from July 2010 to September 2011. Peripheral autofluorescent phenotypes included normal autofluorescence, focal pinpoint hyperfluorescence, granular fluorescent changes, patchy hypofluorescence, and reticular hypofluorescence., Results: One hundred and ten consecutive patients (220 eyes) with a diagnosis of AMD or macular drusen were imaged using ultra-wide-field autofluorescent technology during the study period. Eighty-three patients (157 eyes) were included in the final analysis. Peripheral autofluorescent abnormalities were present in 63.6% of eyes with AMD versus 35.7% of control eyes (p=0.049). Granular fluorescent changes (p=0.0001) and patchy hypofluorescence (p=0.0015) were more common in eyes with advanced AMD than in eyes with early AMD or control eyes. Granular fluorescent changes were also more common in eyes with choroidal neovascularization (p=0.026) or geographic atrophy (p=0.0001). Patchy hypofluorescence (0.0001) was more common in eyes with geographic atrophy., Conclusions: Peripheral autofluorescent abnormalities are common in eyes with AMD. The peripheral findings in eyes with AMD may represent different phenotypes, which may indicate different environmental or genetic factors in the development of AMD. Characterizing the different peripheral phenotypes may have implications for diagnosis and treatment of AMD subtypes., (© 2012 The Authors. Acta Ophthalmologica © 2012 Acta Ophthalmologica Scandinavica Foundation.)

Purpose: Rhegmatogenous retinal detachment (RRD) affects the function of the retina before and after surgical repair. We investigated ultra-wide-field autofluorescence (UAF) abnormalities in patients with acute RRD to improve our understanding of the functional changes in the retina before and after surgery., Methods: In this retrospective study, we present the UAF imaging findings of 16 patients with acute, non-traumatic RRD. Imaging was obtained with the Optos 200 Tx (Optos) in 14 eyes preoperatively and in 12 eyes postoperatively. Twelve eyes had RRDs that involved the macula (group A), whereas four eyes had macula-sparing RRDs (group B)., Results: All patients (100%) with bullous retinal detachments demonstrated hypofluorescence over the area of retinal detachment. A hyperfluorescent leading edge (HLE) to the retinal detachment was observed preoperatively in 100% of eyes in group A and 75% of eyes in group B. Preoperative UAF through the fovea of group A eyes was normal (30%), hypofluorescent (50%) or hyperfluorescent (20%). In all patients with a HLE preoperatively, the HLE resolved by the 1-month postoperative visit. A residual line of demarcation remained in 8 of the 12 eyes (67%). In group A eyes, postoperative granular autofluorescent changes were present in four of the nine (44%) eyes, and were associated with worse preoperative (P=0.04) and postoperative (P=0.09) visual acuity., Conclusion: UAF imaging reveals abnormalities in RRDs that allow excellent demarcation of the extent of the retinal detachment and assist in preoperative characterization of the detachment and postoperative counselling.

Purpose: To determine the relationship between retinal ischaemia and the presence of macular oedema (DMO) in patients with diabetic retinopathy (DR) using ultra-widefield fluorescein angiography (UWFA) imaging., Methods: A retrospective review of 122 eyes of 70 treatment-naïve diabetic patients who underwent diagnostic UWFA using the Optos 200Tx imaging system. Two independent, masked graders quantified the area of retinal ischaemia. Based on clinical examination and optical coherence tomography (OCT), each patient was given a binary classification as either having DMO or no DMO. McNemar's test (with Yates' correction as indicated) and a two-sample test of proportions were used to determine the relationship between DMO and ischaemia for binary and proportional data, respectively. Linear and logistic models were constructed using generalised estimating equations to test relationships between independent variables, covariates and outcomes while controlling for inter-eye correlation, age, gender, haemoglobin A1c, mean arterial pressure and dependence on insulin., Results: Seventy-six eyes (62%) exhibited areas of retinal ischaemia. There was a significant direct correlation between DMO and peripheral retinal ischaemia as seen on UWFA (p<0.001). In addition, patients with retinal ischaemia had 3.75 times increased odds of having DMO compared with those without retinal ischaemia (CI 1.26 to 11.13, p<0.02)., Conclusion: Retinal ischaemia is significantly correlated with DMO in treatment-naïve patients with DR. UWFA is a useful tool for detecting peripheral retinal ischaemia, which may have direct implications in the diagnosis, follow-up and treatment such as targeted peripheral photocoagulation.

Purpose: To evaluate patients with diabetic retinopathy using ultra-wide-field fluorescein angiography and to compare the visualized retinal pathology with that seen on an overly of conventional 7 standard field (7SF) imaging., Methods: Two hundred and eighteen eyes of 118 diabetic patients who underwent diagnostic fluorescein angiography using the Optos Optomap Panoramic 200A imaging system were included. The visualized area of the retina, retinal nonperfusion, retinal neovascularization, and panretinal photocoagulation were quantified by two independent masked graders. The respective areas identified on the ultra-wide-field fluorescein angiography image were compared with an overly of a modified 7SF image as outlined in the Early Treatment Diabetic Retinopathy Study., Results: Ultra-wide-field fluorescein angiograms imaging, on average, demonstrated 3.2 times more total retinal surface area than 7SF. When compared with 7SF, ultra-wide-field fluorescein angiography showed 3.9 times more nonperfusion (P < 0.001), 1.9 times more neovascularization (P = 0.036), and 3.8 times more panretinal photocoagulation (P < 0.001). In 22 eyes (10%), ultra-wide-field fluorescein angiography demonstrated retinal pathology (including nonperfusion and neovascularization) not evident in an 7SF overly., Conclusion: Compared with conventional 7SF imaging, ultra-wide-field fluorescein angiography reveals significantly more retinal vascular pathology in patients with diabetic retinopathy. Improved retinal visualization may alter the classification of diabetic retinopathy and may therefore influence follow-up and treatment of these patients.

Purpose: In this study, we demonstrate the use of wide-field photography and fluorescein angiography to visualize the peripheral vascular changes and to identify patients with risk factors for developing proliferative sickle cell retinopathy., Methods: This is a retrospective case series of 12 eyes of 6 patients with sickle cell disease. Visual acuity testing, slit-lamp biomicroscopy, dilated fundus examinations, and noncontact wide-field fundus photography and fluorescein angiography using Optomap scanning laser ophthalmoscope (Optos, Marlborough, MA) were performed in all patients. The retinopathy was classified into proliferative and nonproliferative retinopathies, and the extent of retinopathy was measured in degrees. Wide-field images obtained using Optomap were compared with the derived seven-standard field images., Results: At the time of initial examination, 50% of the total eyes had proliferative retinopathy. All the peripheral retinas and vasculature were easily imaged within a single frame with Optomap. Six eyes met the high-risk criteria for developing proliferative changes. None of the eyes in our case series had tractional retinal detachment. The degrees of any type of sickle cell retinopathy and active neovascularization ranged from 20° to 360° and 10° to 60°, respectively. In all but one eye, wide-field images detected peripheral vascular changes missed on the seven-standard field photographs., Conclusion: Wide-field fluorescein angiography and color photography enhance clinicians' ability to visualize peripheral vascular remodeling in sickle cell disease and to identify high-risk characteristics for proliferative sickle cell retinopathy.